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in accordance with the doctrine of descent, have been adjusted to those great environing alternations of day and night, of months and of seasons; adjustments which are not to be lightly regarded, and alternations which admit of no abrupt or large interference if the muscle, the limb, the organism, the species is to be progressive. I had intended also to engage with man in some of his relations to his fellow men in communities; and with the question how far artificial selection, which has been so largely operative in the case of man, is to be allowed to take the place of natural selection. Time, however, forbids. And, by way of conclusion, I would repeat the question, with which I set out, as to the position which we as Members of the Profession of Medicine shall adopt in reference to the doctrines advanced by Lamarck and Goethe, by Spencer, by Darwin and Wallace, and by the great army of biologists who have followed them; for, if there be truth in those doctrines, it becomes incumbent on us to give what aid we can towards building up a complete Biology, as a science which must ultimately take cognizance of all conditions of life, regular and irregular, normal and abnormal, healthy and diseased.

Australian Medical Journal.

MARCH 20TH, 1895.

ANTITOXIN TREATMENT OF DIPHTHERIA.

Dr. Cherry has contributed to this number of the Journal an interesting account of his views upon diphtheria antitoxin, and it is clear that he believes that the treatment by antitoxin has been already practically established as a most valuable therapeutic measure. Such an expression of opinion comes with great force from one who has devoted several months to the special study of the subject, who has seen the treatment carried out on a large scale in Paris and Berlin, and who has, as it were, rubbed shoulders with Roux and Behring, and we earnestly trust that Dr. Cherry's conviction may prove to be permanently true.

As is only natural, each month brings to light some modification in the methods of procuring and administering the dose of antitoxin, indeed the changes in the dosage have

been made the subject of an attack upon the value of the treatment, for it is asked, if Behring obtained wonderfully good results with his former doses of antitoxin, why should he now increase the dose three-fold. It must be pointed out that the solutions of diphtheria antitoxin vary very much in strength; and for the quantitative estimation of the strength, Behring has set up as a standard a "normal serum." Of this serum, "one-tenth of a cubic centimetre, when injected with ten times the minimal dose of diphtheria poison fatal for guinea-pigs weighing 300 grms., prevents the occurrence of any ill effects. One cubic centimetre of the normal serum' is spoken of as a normal antitoxin unit,' or as an 'immunity unit." The dosage then should be stated for scientific reference in terms of " immunizing units," and not in cubic centimetres of the solution. As a rule, the antitoxin solution is put up in small bottles, each of which contains a dose of 200 " units," and accompanying the bottles are directions which show the number of cubic centimetres of the solution necessary for an injection of a proper dose.

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Enormous differences of strength occur in the preparations of antitoxin produced by Roux, by Behring, by Aronson, or by Klein. Until the strengths of these solutions is reduced to something like uniformity, it will be puzzling to follow the records as to dosage. To us here, it is of paramount importance to know whether the samples of serum which reach us have or have not been affected by the heat during the voyage from Europe, and we think it is very right and wise that Dr. Cherry should have made arrangements to test, quantitatively, samples of serum, and so be able to indicate the proper hypodermic dose. If it is found that the samples of serum have been changed to any extent during transit, it will then of course be necessary that the whole work of immunization of horses, and the preparation of antitoxin solution should be undertaken by capable experts in the colony.

Cases of diphtheria are yearly increasing in number throughout England, and we think it is quite probable that in the next year or so, we may have among us diphtheria

in an almost epidemic form again, so it is our bounden duty to have ready to hand every means by which it may be possible to combat that disease.

Reviews.

Post-Nasal Growths. By CHARLES A. PARKER, Assistant Surgeon, Hospital for Diseases of Throat, Golden Square, London. 98 pp. 8vo. London: H. K. Lewis, 1894.

Whilst dealing with the whole question of Post-Nasal Growths, this book appears to have been written for the sake of the second chapter, in which the author endeavours to show (and, we think, successfully) that in nasal obstruction, especially when caused by post-nasal growths, respiration is nasal, and not buccal, during sleep.

In his opening chapter the author dwells upon the fact that, even now, some practitioners do not recognise the existence or the influence of these growths, though the number of cases operated upon, and the successes obtained, have been very great. It cannot be too earnestly impressed upon the general practitioner, that in all cases of deafness or ear trouble in children, the naso-pharynx should be examined. It has been estimated that from 70 to 95 per cent. of persons with post-nasal growths suffer from some form of ear trouble.

In investigating the mode of respiration in these cases during sleep, at the suggestion of Dr. Greville MacDonald, Dr. Parker thinned out a small piece of cotton-wool, twisting up one end and making the other spatulate, but all so delicate that the slightest breath of air would move it. The broader end was held first in front of the mouth, and then in front of each nostril, its movements readily showing through which passage or passages the air was entering. The results showed that, in the vast majority of cases, the air enters the lungs almost entirely through the nose during sleep, however great may be the difficulties, and though the mouth be kept wide open. For the author's explanation of the cause of snoring, &c., we must refer readers to the book. The inadvisability of sending these cases to the seaside is noted. Complete clearance by instruments of the naso-pharynx under chloroform is

the remedy adyocated, and the inutility of methods short of this demonstrated; recurrence, save in syphilitic cases, and in infants too young for the appropriate after-treatment, being ascribed to the adoption of less complete operative methods.

The book is well printed and well written, and should be read by all who have to deal with affections of the ear, nose, throat, or with children's practice.

A. L. K.

A Manual of Modern Surgery, General and Operative. By JOHN CHALMERS DA COSTA, M.D.

This small work, according to its author, "seeks to stand between the complete but cumbrous text-book, and the incomplete but concentrated compend." It is not very clear what good purpose any such intermediate production as that projected by Dr. Da Costa could be supposed to serve, and a perusal of this work does not in the least enlighten the reader. It is impossible to criticise it quite seriously, and difficult to find anything in it of importance to single out for favourable notice. Suffice it to say that, in this small book of less than 800 pages, Dr. Da Costa flits over the whole domain of modern surgery, from bacteriology to bandaging, touching upon everything, but giving a complete account of nothing. Not only is the whole style of the book extremely cursory and condensed, but it abounds in omissions and mis-statments which are unpardonable. For instance, among the symptoms of abscess of the brain, no allusion is made to the pulse and respiration phenomena; while the whole subject of hydatid disease, including the treatment, is disposed of in six exquisitely humorous lines, which merit quotation; they are as follows:-" Hydatid cysts occur particularly among people who live shut up with dogs, as is the case in Iceland. The parasite is swallowed with the food and is taken up by the stomach veins, and penetrates the intestine and peritoneum to find a nest in some neighbouring or distant organ or tissue. Open these cysts, scrape, asepticise, and pack with iodoform gauze." The illustrations, though small, are some of them meritorious and novel; but those devoted to bandaging can hardly fail to arouse feelings of astonishment and dismay. The illustrations portraying the application of splints to the arm are excellent, as showing how the work should not be done, and it is not surprising to find, on referring to the text, that in the author's experience of fractures into or near the elbow

joint, "the prognosis for complete restoration of function is bad, and in most of these fractures some deformity and considerable stiffness are inevitable." It is probably a fortunate circumstance that the book is written in a singularly unattractive style, which it is to be hoped will prevent it from gaining the position which otherwise it would bid fair to acquire among popular cram-books of the most pernicious kind.

R. H. R.

Modern Materia Medica, for Medical Men, Pharmacists, and Students. By H. HELBING, F.C.S. Fourth enlarged edition. Publishers: Lehn and Fink, New York. London: H. K. Lewis, 1895.

A new edition of this excellent little work has been demanded, owing, not only to the conspicuous development of the literature of chemical and pharmacological substances, but also to the large number of new synthetical remedies that are still being introduced into medicine in this "new-remedy era." The edition under notice is larger by three times than that published three years ago, and by reason of later chemical researches concerning synthetical drugs, and further clinical experience, many parts have been entirely re-written.

The book is divided into three parts. The first deals with synthetical compounds with up-to-date completeness, discussing their preparation, physical and chemical properties, medicinal uses, derivatives and allied compounds. Take e.g. Antipyrine, its seven synonyms are first enumerated, the history, preparation, and pharmacy of the drug are then detailed; useful hints as to modes of administration, incompatibility, &c., are given, and finally, twenty-three derivatives and allied compounds are described, the whole occupying ten pages. The second part of the work deals with compounds that are of less importance, and with those that are not purely synthetical remedies.

The third part consists of tables of doses for children and adults, solubilities, melting and boiling points of the new drugs. Perhaps the most valuable table is that of special tests for a number of the newer remedies in the urine. These must prove useful, not only in facilitating the detection of these drugs in urine analysis, but also in " explaining abnormal appearances or behaviour in the application of clinical tests."

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